Provider Demographics
NPI:1821136276
Name:GALLICHIO, LAWRENCE JOSEPH (LMHC,CAP)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:JOSEPH
Last Name:GALLICHIO
Suffix:
Gender:M
Credentials:LMHC,CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6270 N ANDREWS AVE
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-2129
Mailing Address - Country:US
Mailing Address - Phone:954-772-7696
Mailing Address - Fax:954-977-3085
Practice Address - Street 1:6270 N ANDREWS AVE
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-2129
Practice Address - Country:US
Practice Address - Phone:954-772-7696
Practice Address - Fax:954-977-3085
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL438101YA0400X
FL4097101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health